MAKING THE CONNECTION

Guide to assessing the housing related needs of older and disabledhouseholds

MAY 2015

Author: Gillian Young

(Newhaven Research Scotland)

1.INTRODUCTION

Who is the guide primarily for?

Policy context

Making connections

Purpose and structure of guide

What this guide is not?

Key terms

Key lines of enquiry

2.PLANNING AND MANAGING THE PROCESS

Introduction

Discussions on how to organise and knit analysis together

Possible division of responsibilities

Upstream interventions

A matter of geography

Assembling the evidence base

3.PREPARING THE EVIDENCE BASE

Introduction

How are the numbers of older and disabled households changing?

The stock of specialist and accessible housing

The housing, care & support arrangements of older and disabled households

Housing adaptations and other property related services

The responsiveness of the housing system to older and disabled households

Older and disabled households expectations and concerns

Estimating needs

Estimating specialist provision to meet needs

Potential shortfalls in specially designed or adapted housing

Potential shortfalls in supported housing intended for permanent residence

Limitations of long range predictions for specialist housing provision

4.CONCLUDING OBSERVATIONS

Bringing it altogether

Improving evidence

Learning from good partnerships

APPENDIX 1: USEFUL REFERENCE MATERIAL

Useful documents

Useful websites

APPENDIX 2: GLOSSARY OF KEY TERMS

APPENDIX 3: PROCESSING AND INTERROGATING DATA

Introduction

Main sources of secondary data

High level auditing of secondary data

Thinking about statistical analysis

Offering some insight to the reasons for trends

Projections, forecasts and scenarios

Be clear about basis of any predictions

APPENDIX 4: CORE AND HARMONISED SURVEY QUESTIONS

Other equalities information

APPENDIX 5: NATIONAL SURVEYs and HOUSING DATA

The Health and Care Experience Survey

The Scottish Household Survey (Including the SHCS)

APPENDIX 6: PREVALENCE RATES

Using prevalence rates

Possible prevalence rates of interest

Prevalence rates for housing related services

APPENDIX 7: SPECIALIST HOUSING CHECKLIST

1.INTRODUCTION

Who is the guide primarily for?

1.1This guide has been developed as a companion to and not a replacement for the Scottish Government (2014) Housing Need and Demand Assessment (HNDA): A Practitioner’s Guide.

1.2It offers non prescriptive advice to help strategic planners engaged in the HNDA and the Joint Strategic Needs Assessment (JSNA) process to work together to develop a shared perspective of the needs and demands of older households and households that contain someone with a physical disability, learning disability, and/or a mental health problem.For ease of reference, the generic term of older and disabled households is used in this document.

1.3It is still early days and this guide will be modified and added to as learning and experience builds. We would therefore welcome feedback on how this guide might be improved plus illustrative examples of analysis that could be shared through the JIT or CHMA website.

Policy context

1.4High quality places, homes and housing related services enhance the living conditions, health and wellbeing of individuals and the communities in which they live. The Scottish Government has therefore stressed the vital role of housing and planning in creating well-designed, high quality and sustainable homes and places that are accessible to people regardless of age or ability[1].

1.5The incorporation of Housing Contribution Statements into the Joint Strategic Commissioning Plan has been an important step towards better engagement. The Scottish Government's ambitious programme to integrate health and social care, however, createsfurther possibilities for those involved in planning for housing, places,health and social care to collaborate[2].

1.6The Public Bodies (Joint Working) (Scotland) Act 2014 is pivotal to the Scottish Government’s ambitions tointegrate health and social care, to alleviate health inequalitiesand to achievebetter outcomes for individuals. Integration is expected to shift the balance of care from acute to community-based settings and to ensure that resources, services and preventative measures meet the needs and preferences of individuals and local communities.

1.7Integration began to go live in April 2015. The new Integration Authorities have responsibility for planning, resourcing and co-ordinating community based health and social careservices. These new bodies are required to prepare a Strategic Commissioning Plan (SCP) by April 2016 and to:

  • Establish a Strategic Planning Group that includes housing representation, to oversee the development and implementation of the SCP.
  • Establish two or more locality planning arrangements that to enable health and care professionals, service providers, service users and others to shape the planning and delivery of services to reflect local needs.
  • Ensurethat their SCP priorities are aligned with those of the Community Plan and other local strategies, such as the Local Housing Strategy (LHS) and Strategic and/or Local Development Plans (SLDP).
  • Secure a diversity of services to facilitate Self Directed Support (SDS) and give individuals real choice and control over the content and, if desired, the purchase of their personal care and support packages.

1.8Scottish Government guidance confirms that each SCP will be underpinned by an assessment of the health and care needs of the population. The new style JSNA will have to look beyond measures of mortality, morbidity and service utilisation in order to:

  • Establish how many people have care and support needsand the types of services they might require.
  • Develop a deeper understanding of the supply and demand forservicesas well as gaps in service delivery, including preventative services.

1.9Spatial planning and housing planners are well placed to collaborate with health and social care planners to meet these new demands. They have access to a wealth of data and practice based knowledge about local communities and the factors that make dwellings, neighbourhoods and local services work (or not work) for older and disabled households.

Making connections

1.10As figure 1.1 illustrates, there are connections between the new style JSNA and HNDA at the analytical level and between the SCP, the LHS and the SLDP at the strategic and operational level. The new health and social care planning framework offers a springboard for those engaged in these analytical and strategic processes to come together to:

  • Develop a deeper shared understanding of local population dynamics and communities, the services and assets that exist and how these are distributed across the local area.
  • Broaden understanding of the structure and features and of local housing systems and neighbourhoods and how these facilitate or hinder individuals to live independently for as long as possible.
  • Assess the potential role of specialist housing and well-designed mainstream housing for older and disabled households.
  • Consider ways in which housing providers could reach people before they require more costly interventions and contribute to the Integration Authority’s goal to deliver preventative and earlier intervention.

Figure 1.1: Links between Housing, Strategic Development and Strategic Commissioning

Purpose and structure of guide

1.11As stated at the outset, this guide is focused on the connections between the HNDA and the JSNA process, which is shown by the red arrow in figure 1.1. It offers suggestions about how the local HNDA and JSNA processes could develop a common evidence base and pool resources to:

  • Undertake a more comprehensive needs assessment that looks at care, support and housing needs and minimises the risk of duplication of effort.
  • Examine other issues of common concern that reflect local circumstances, and the priorities of Integration Authorities and LHS Partnerships.

1.12This guide consists of 4 main sections, including this introduction (section 1). Thereafter:

  • Section 2 provides an overview of issues that those engaged in preparing the HNDA and the JSNA may want to consider in framing and organising collaborative work.
  • Section 3 offers suggestions on analysing a number of topics that could be brought together to develop a fuller picture of the needs and wants of older and disabled households and to address the key lines of enquiry set out in table 1.2 below.
  • Section 4 offers some concluding observations.

1.13The guide also includes a series of appendices:

  • Appendix 1 contains references and websites to alert readers to useful material above and beyond the extensive listing prepared by the Centre for Housing Market Analysis (CHMA) to accompany the HNDA Practitioners Guide and the ISD Scotland Guide to Data to Support Joint Strategic Needs Assessment.
  • Appendix 2 sets out a glossary of terms whilst appendix 3 provides an overview of the issues relating to the assembly, processing and analysis of secondary data sources.
  • Appendices 4 to 7 contains further details in relation to issues discussed in section 3.

1.14Whilst various data sources are referred to, this guide does not recommend any specific datasets or indicators. Aside from the fact that CHMA and ISD Scotland have already produced extensive listings, the evidence used to inform local analysis will depend on local circumstances, and the topics that matter most in each local authority area.

What this guide is not?

1.15Housing and planning will want to forge better strategic and operational links with the Integration Authority and ensure that the desired outcomes set out in the SCP support investment in places, housing and housing services. Joint analysis to develop a better understanding of issues of common concern should provide a better foundation for agreeing desired outcomes and priorities for investment. However, as neither the HNDA nor JSNA are directly concerned with strategy formulation, this is not a guide to the development of policies and preventative services that will achieve healthier individuals and communities.

1.16This guide does not consider the housing related needs of individuals at risk of homelessness, ex-offenders, those with addictions and Gypsy/Travellers. However, it is hopedthat issues discussed in section two will be of assistance in thinking about how to organise analysis for these population sub-groups.

1.17This guide does not offer step by step advice on how to complete the HNDA Practitioners Guide specialist provision templates. Nonetheless, it is hoped that joint working to prepare the HNDA and JSNA will go a long way to securing the evidence required to achieve the third of the four core HNDA outputs, which the Scottish Government define as:

"Specialist Provision: Identifies the contribution that Specialist Provision plays in enabling people to live well, with dignity and independently for as long as possible. Identifies any gap(s)/ shortfall(s) in that provision and the future level and type of provision required. Considers evidence regarding property needs, care and support needs and locational needs. Gives due consideration to the provisions of the Equality Act (2010)" Scottish Government (2014) HNDA Practitioners Guide, p 37.

Key terms

1.18The definition of specialist provision adopted in the HNDA Practitioners Guide is wide ranging and encompasses everything from care homes to peripatetic support. This reinforces the inter-relationship between housing, health and social care but it can create terminological tangles. For ease of reference this document therefore uses the terms set out in table 1.1.

Table 1.1: Specialist provision- summary definition of terms

Term / Definition
Specialist housing provision / Specially designed housing, including wheelchair accessible housing:Purpose built, remodelled or substantially adapted dwellings that include special design features that are suitable for a household that contains someone with mobility, sensory and/or cognitive impairment. Amenity housing and retirement housing (which is the term private providers prefer) can fall into this category.
Supported housing: Generally self-contained units clustered together on a single site or dispersed across a neighbourhood, where housing support, and occasionally care, is an integral part of the accommodation package. Dwellings often include special design features for people with mobility, sensory and/or cognitive impairments. Private providers tend to use the term assisted living.
Care homes / Care Homes: Provide a residential setting where older and disabled individuals (rather than households) live, usually in single room with on-site care and support.
Ordinary housing / Ordinary housing: Also referred to as general needs and mainstream housing. Includes accessible homes, such as bungalowsand ground floor flats that comply with the enhanced accessibility and adaptability standards embedded in Building Regulations from 2007 and more especially from 2010 onwards.
Formal care and support (community based) / Community health services: Covers a range of services including GPs, community pharmacists and community nursing.
Social care: This term covers a diverse range of services such as: personal and home care services to assist with daily activities such as washing, dressing, getting in/ out of bed; reablement services to assist people to carry out daily activities without support; respite care, and other support to carers.
Telecare: Community alarms and various remote facilities to monitor and detect risks, such as falls, fire or when person with dementia leaves their home or a defined area.Although some social landlords provide these services, telecare services are increasing provided or funded by social care.
Housing related services / Housing support: Services to assist people to sustain independent living such as budgeting, welfare benefit claims and debt management advice and general counselling.
Equipment and adaptations: Provision and installation of handrails, walk-in showers and other aids to help carry out bathing, other everyday tasks and moving around the home.
Property related services: Services such as Care and Repair, that assist people maintain, repair and adapt their home so that they can live in safely and in comfort.
Upstream health and wellbeing promotion and preventative interventions / Wider role services: Social landlord activities to make communities safer, healthier, more vibrant and better places to live. This can include actions to reduce antisocial behaviour and fear of crime, to promote healthier living and to boost access to training and employment.
Planning policies: Work of strategic and local development planners to ensure the built environment and public spaces are arranged in a way that facilitates access by individuals with reduced physical and sensory abilities and to ensure neighbourhoods are conducive to walking, cycling, socialising etc.
Information and advice: Independent service to help people to review their housing, support and care options, taking into account their individual preferences as well as their health and financial circumstances.

Key lines of enquiry

1.19Table 1.2 outlines a set of key lines of enquiry and associated supplementary questions.The key lines of enquiry cover a lot of ground and it is not expected that planners will address each and every issue simultaneously. Instead it is hoped that this table will guide discussions about:

  • The most pressing local issues where analytical efforts should be focused.
  • The scale and scope of analysis for the coming months and elements of existing analysis that will need to be updated or enhanced.
  • Core issues to be addressed over a longer timeframe and the actions to be pursued to ensure that the necessary resources, capabilities and evidence base are put in place to support such analysis.

1

Table 1.2: Suggested key lines of enquiry

Key issue / Supplementary questions planners may wish to explore
How are the numbers of older and disabled households changing? /
  • How many individuals with a long term health problem or disability live in the community in their own home as distinct from an institutional setting?
  • What proportion of all older and disabled households, such as those in receipt of disability benefits, form the “population at risk” for whom some form of specialist housing or housing related service may be potentially appropriate?
  • How might these numbers change in the decade ahead?

What are the housing arrangements of older and disabled households, including those in receipt of social care? /
  • What is the profile of housing occupied by older and disabled households (provision type, receipt of care, tenure etc) and how has this profile changed in recent years?
  • Have the numbers of older and disabled households living in the privately owned and/or rented housing increased? Have market forces been the main driver of change or have other factors, such as housing allocation policies, played a role?
  • Does the tenure profile of households in their 50s suggest that the proportions of older households that are homeowners will continue to increase or stabilise over the next decade and beyond?
  • Are there marked variations in the patterns of formal care and housing related services delivered to older and disabled households in each tenure? Are these patterns consistent with variations in health and disability or are other factors at play?
  • Are there local communities with high concentrations of older and disabled households in receipt of disability benefits but relatively few people in receipt of formal care or housing related services? If so, what factors might explain this?

How is the structure and shape of care home and specialist housing market changing? /
  • Have the numbers of care homes places, specialist housing units and ordinary dwellings of an accessible design changed in recent years? How does the rate of provision compare with national rates per 1,000 people in the client group?
  • What is the balance of provision between care homes and specialist housing provision in terms of both the total number of places and the annual flow of places that become available for let or purchase each year?
  • Are vacancies in some developments more difficult to fill, and if so why?
  • What provision is there for short-term alternatives to in-patient care and for respite care? Is it judged to be adequate?
  • Is the specialist housing and care home market stable or are providers looking to change their model of provision, upgrade provision or exit the sector altogether?
  • Are providers interested in developing alternative models of specialist housing provision such as equity based housing models or mutual housing where people can provide support for each other?
  • What is happening in terms of the market for adaptations and other housing related services?
  • What factors are shaping the responses and forward plans of providers?

In what ways does the operation of the housing system create barriers for older and disabled households? /
  • What challenges do older and disabled households face in securing suitable specialist or ordinary housing or in accessing advice and information on housing options, formal care and housing related services?
  • How do the consumer costs of different forms of provision compare? Is there a large gap between the price of specialist housing or suitably designed ordinary housing and the price of homes older and disabled homeowners typically occupy?
  • What factors discourage people from moving to a more suitable home or accessing formal care or housing related services? Is price a factor in influencing consumer take-up of the available options?
  • What do these patterns suggest in terms of the potential for options such as trading down, specialist housing and raising equity to fund repairs, housing adaptations and other services?
  • Is there a potential untapped market for well designed, ordinary housing for older and disabled households, especially those in their 50s to 70s?
  • Is there a sufficient range of trusted and reliable local services and products to give older and disabled households the confidence to use their own resources in ways that support their independence and improve their quality of life?
  • Do local communities with a concentration of older and disabled households contain features that promote wellbeing such as attractive and walkable public spaces and provide easy access to GPs, other services andpublic transport?

What volume of care homes, specialist and suitably designed ordinary housing might be needed? /
  • How many older and disabled households are estimated to live in unsuitable housing that makes it difficult or impossible to carry out one or more daily activities within the home?
  • What proportion of older and disabled households with unmet need may be able to have their needs resolved through some form on in-situ solution or through using their own resources to secure a suitable home?
  • What is the estimatedshortfall in the volume and type of provision for older and disabled and where might it be located?
  • What risks are associated with the shift to SDS and greater consumer choice and how will they be monitored?

What overall conclusions can be reached? /
  • How well suited is the supply of care homes and housing to the needs and wants of older and disabled households? What are the main mismatches between the options that are available and the tenure profile, financial resources and expectations of older and disabled households?
  • Is there a broad consensus that there is substantial shortfall in the supply of care homes and/or specialist housing provision in one or more tenures? What ‘hard’ evidence is there to support perceptions?
  • What are the key challenges that will have to be addressed if the housing stock, formal care, housing related services and upstream services are to better meet the needs and preferences of older and disabled households in all tenures?
  • What further analysis is required to better understand, and if necessary, quantify issues of local concern? When and how will the most critical gaps in the evidence base be addressed?

1